Healthcare Provider Details

I. General information

NPI: 1689717381
Provider Name (Legal Business Name): ANDREA M LOPERENA MFC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 N FAIR OAKS AVE SUITE 100
PASADENA CA
91103-1620
US

IV. Provider business mailing address

1855 N. FAIR OAKS AVE. SUITE 100
PASADENA CA
91103
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-7710
  • Fax: 626-296-7714
Mailing address:
  • Phone: 626-296-9971
  • Fax: 626-296-7714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49042
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberIMF42218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: